Emergency rooms cont'd

Yesterday, I wrote about the time mismatch between patients and their doctors that sends so many people to spend unnecessary hours in the emergency room. I also quoted a study suggesting that other countries have figured out how to make primary care a bit more convenient. But Aaron Carroll does me one better and puts up a graph:

There are certain facts that Americans hear about the Canadian system -- that they often wait weeks or even months for elective surgeries, for instance -- and they just can't believe that modern human beings would allow themselves to be put through such misery. But by the same token, there are facts that people in other countries hear about our system -- that we often don't get needed surgeries because we can't afford them, or that our doctors won't see us at night or on weekends or in our homes -- and they're similarly aghast that citizens of the richest nation in the world would not just accept that sort of a system, but pay extra for it.

Mr. Klein compares the delivery of medical care in the United States to that in other countries. From country to country, providing treatments for the same disorders may be similar, but delivering those treatments varies widely. The United States is not Switzerland.

There is one commonality, however . . . science; not biological but behavioral. Seeking medical care is a behavior. Providing medical care is a behavior. We have a science the origins of which date back more than a century to describe the principles that control those behaviors. Few politicians, bureaucrats, and profiteers want any part of it. I know.

In 1991, I served as a physician-consultant for healthcare reform to the government in Sweden. I wrote a lengthy and well-received report translated into Swedish.

In 1994, in opposition to ClintonCare, and extrapolating from my Swedish experience, I wrote a book entitled Healthcare Reform D.O.A. (out-of-print; available used via the Internet).* The book traced the history of medical delivery in America, provided a critique of ClintonCare, described the scientific principles to design a system of delivery, presented an alternative plan based on those principles, and documented the misrepresentations in Clinton’s popular paperback compared to the actual legislation.

In 1994, the American Medical Association refused even to run an ad for the book. In 1995, unsolicited, the book received nominations for two national awards by the American Risk & Insurance Association.

Level of interest by politicians and their sycophants? Zero. The consequence fifteen years later? ObamaCare.

In a new, fictional/nonfictional book entitled Inescapable Consequences (www.inescapableconsequences.com), I’ve woven into the plot an updated version of the plan. It brings it further into conformity with the Constitution and American Tradition. Most importantly, it’s an approach based upon science not politics, power, “pork”, and personality. In the unlikely event of a repeal of ObamaCare or of a judgment declaring it unconstitutional, politicians and voters will have a credible example of an American-oriented system scientifically-based and scientifically-driven versus politically-motivated and politically-manipulated. Will the politicians care? Only if the voters make them.

I don't have the data in front of me, but I'd be curious how this graph overlays with primary care reimbursement and whether physicians get some equivalent of "overtime" when they see patients during off hours. Primary care visits during daytime hours are barely reimbursed by private insurance (and with Medicaid many doctors actually lose money), so I'd be willing to bet this is a case of economics. If we did reimburse those after hours visits a little more (but for instance substantially less than an ER visit), I bet it would open up more possibilities for this type of care in the US.

It is good the ACA at least starts to prioritize primary care a little more - it may lead to US doctors changing their practices to the benefit of patients. I'm currently in a US medical school and none of my classmates have any interest in primary care - mostly because it won't allow us to service our loans in any reasonable amount of time.

One thing not mentioned: a growing number of "quick-care" clinics located in retail outlets such as Walgreen's and CVS pharmacies and Target are popping up all over. Never used one (take it back: got a flu vaccination at a nearby supermarket pharmacy once), but I might if I found myself with a normal type of need on a Sunday morning. I'm looking at Walgreen's website, and they will treat things like respiratory illnesses, minor injuries, skin conditions, minor diagnostic testing, vaccinations, physicals, etc. They take insurance, or the prices are pretty low if you don't have it. Anyone have a comment on these types of health-care alternatives to the emergency room for everyday illnesses?

WOW. are you really saying that people with insurance don't abuse the ER system and only go to the ER for true emergencies? But i'm sure that your own specific experience with insurance is the same as every single American. That makes a ton of sense.

JJenkins,

yes those "minute clinics" are popping up all over as a money boon to pharmacies and an alternative to doctors offices but its important to note that their services they perform are and should be limited. You don't want to go there with a broken arm. or serious illnesses or injuries. Like nurse practitioners there's a limit to what they can and should do IMO.

Also don't see any mention of Urgent Care clinics that have become more prelevant all over the country. These clinics take walk in patients, have real doctors on site, are open late and are open 7 days a week. The waits typcially aren't any longer than a wait at your regular doctor's office.

In the UK you need an appointment to see a doctor. The government brought in a requirement that patients had to be seen within 48 hours - doctors just stopped answering the phone when they were booked up. I know this to be true from my mother.

I don't know where they get the 89% of practices have arrangements to see a doctor after hours - it probably means patients can go to local hospital (free of charge). I can guarantee they won't be making house calls!

Those numbers seem a little fishy to me. It may be regional, but in the ten years that I've been in practice, I've always belonged to a practice with urgent care clinics. In my current job we have 2 walk-in clinics that are open 365 days per year. I have to do a few shifts in the urgent care each month. On Friday night I saw a mere 5 patients, but on Monday, the holiday, I saw 27! Maybe it's just a southern California thing, but there are at least three urgent care clinics within a 5 mile radius of my house.

Like most studies in this topic, its a "conclusion in search of evidence" as it absolutely ignores the recent trend of late night urgent care clinics that have opened up by the tens of thousands in this country. I'm sure their stupid little study conveniently ignored urgent care places and only counted brick and mortar traditional doctors offices as places of healthcare services, which is an absolutely ludicrous flaw.

I'll pose a challenge to you guys. Give me a metro area with at least 50k residents and I GUARANTEE YOU I will find a urgent care clinic that is open till at least 8 PM within a 20 mile radius.

Getting into a clinic is not a problem. People are still abusing the ER left and right, and its not because all the doctors offices are closed.

We encourage users to analyze, comment on and even challenge washingtonpost.com's articles, blogs, reviews and multimedia features.

User reviews and comments that include profanity or personal attacks or other inappropriate comments or material will be removed from the site. Additionally, entries that are unsigned or contain "signatures" by someone other than the actual author will be removed. Finally, we will take steps to block users who violate any of our posting standards, terms of use or privacy policies or any other policies governing this site. Please review the full rules governing commentaries and discussions.